%0 Journal Article
%T Clinical Correlates of Awareness for Balance, Function, and Memory: Evidence for the Modality Specificity of Awareness
%A Megan E. O'Connell
%A Vanina Dal Bello-Haas
%A Margaret Crossley
%A Debra Morgan
%J Journal of Aging Research
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/674716
%X Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific. 1. Introduction Unawareness, lack of insight, or anosognosia refers to impaired awareness in persons with dementia [1¨C7]. Awareness is multifactorial and likely modular [4, 8¨C10], with each domain separable and potentially unique. Most of the literature on awareness in persons with dementia describes the clinical correlates of one awareness domain (reviews by [1, 4, 11]), but the few studies that have contrasted awareness for different domains have found differential patterns of clinical correlates [12¨C15]. This paper provides further support for the modality specific nature of awareness in dementia by contrasting the clinical correlates for awareness of balance in addition to more commonly measured awareness of day-to-day function and memory. Awareness quantification remains elusive, and there is no consensus method for measuring awareness (e.g., [4, 9]). Awareness has been measured with clinician ratings [16, 17]; or based on discrepancy between self-report versus cliniciansĄŻ impression [10] or versus informant report assessed with interview [10, 18] or questionnaires [7, 12, 14, 19¨C21]; or discrepancy between self-report and objective performance [21, 22], which, depending on the task, measures self-monitoring or metacognitive abilities [3]. Each assessment method has limitations: Clare et al. [21] detail
%U http://www.hindawi.com/journals/jar/2014/674716/